Male circumcision and its association with HIV infection and sexually transmitted diseases: evidence from 18 demographic and health surveys in sub-Saharan Africa

ABSTRACT

The study aimed to assess the association between male circumcision and HIV infection and STDs. The issue is controversial as various studies reported conflicting findings. A cross-sectional comparative study based on the secondary data of 18 Demographic Health Surveys (DHS); carried out in Sub-Saharan Africa starting from 2003; was conducted. From all surveys; information on 70 554 males aged 15 - 59 years was extracted. The association between male circumcision and HIV infection and STD symptoms (genital discharge or genital ulcer/sore) was assessed using binary logistic regression. Adjustment was made for sexual history and basic socio-demographic variables. The weighted prevalence of HIV among men 15 - 59 years was 3.1. In the bivariate analysis uncircumcised status was significantly associated with risk of HIV; with odds ratio (OR) of 4.12 (95 CI 3.85 - 4.42). The association was even more significant (4.95 (95 CI 4.57-5.36)) after adjustment for number of lifetime sexual partners and socio-demographic variables. The risk associated with uncircumcised status is significantly lower among younger men aged 15 - 29 years than those in 30 - 59-year age category. About 5.5 of the study subjects reported either genital discharge or genital sore/ulcer in the preceding 12 months of the surveys. Circumcision status was not significantly associated with either of the symptoms; with adjusted OR of 1.07 (95 CI 0.99 - 1.15). The study concludes that there is a strong association between uncircumcised status and HIV infection. Hence; male circumcision can be considered as a possible way of reducing the spread of HIV infection in areas where the practice is rare. A comprehensive study to assess the association between circumcision and different types of STDs is recommended